Sohei Satoi1, Tomohisa Yamamoto1, Hideyuki Yoshitomi2, Fuyuhiko Motoi3, Manabu Kawai4, Tsutomu Fujii5, Keita Wada6, Hidehito Arimitsu7, Masayuki Sho8, Ippei Matsumoto9, Satoshi Hirano10, Hiroaki Yanagimoto1, Masayuki Ohtsuka2, Michiaki Unno3, Hiroki Yamaue4, Masanori Kon1. 1. Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan. 2. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 3. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. 4. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 5. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan. 6. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 7. Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, Chiba, Japan. 8. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan. 9. Department of Surgery, Kindai University, Faculty of Medicine, Higashiosaka, Osaka, Japan. 10. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Abstract
BACKGROUND: The aim of the present study was to assess recent trends in pancreaticoduodenectomy (PD) and the role of institutional standardization on the development of postoperative complications in 3,378 patients who underwent PD in Japan. METHODS: Data were collected from 3,378 patients who underwent PD in 2006, 2010 and 2014 at 53 institutions. A standardized institution (SI) was defined as one that implements ≥7 of 13 quality initiatives according to departmental policy. There were 1,223 patients in the SI group and 2,155 in the non-SI group. Clinical parameters were compared over time, and between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model. RESULTS: The number of patients who underwent PD in SIs increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs. the non-SI group (P < 0.001). Multivariate analysis revealed that the SI group was associated with a lower incidence of delayed gastric emptying (odds ratio -0.499, P = 0.008) and incisional surgical site infection (odds ratio -0.999, P < 0.001). CONCLUSION: Standardization of care in PD may be important in reducing post-PD complications, and is a critical element for improving clinical outcomes.
BACKGROUND: The aim of the present study was to assess recent trends in pancreaticoduodenectomy (PD) and the role of institutional standardization on the development of postoperative complications in 3,378 patients who underwent PD in Japan. METHODS: Data were collected from 3,378 patients who underwent PD in 2006, 2010 and 2014 at 53 institutions. A standardized institution (SI) was defined as one that implements ≥7 of 13 quality initiatives according to departmental policy. There were 1,223 patients in the SI group and 2,155 in the non-SI group. Clinical parameters were compared over time, and between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model. RESULTS: The number of patients who underwent PD in SIs increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs. the non-SI group (P < 0.001). Multivariate analysis revealed that the SI group was associated with a lower incidence of delayed gastric emptying (odds ratio -0.499, P = 0.008) and incisional surgical site infection (odds ratio -0.999, P < 0.001). CONCLUSION: Standardization of care in PD may be important in reducing post-PD complications, and is a critical element for improving clinical outcomes.